AI Request

How does it Work?

  • Complete our easy Additional Insured request form.
  • Once completed, click the “Submit Info” button. The information will be directed to a licensed insurance agent.
  • Please remember to include your requester’s fax # or e-mail address.
  • Or download, print and FAX the AI Form
  • Turn around is immediate. Just sit back and relax!
Your Business Name(required)

Your Email (required)

Your Phone Number:

Entity requesting to be added as Additional Insured:

Phone Number for Entity requesting to be added as Additional Insured:

Fax Number for Entity requesting to be added as Additional Insured:

Address:

City/State/Zip:

Is work to be done: (please mark)

New Construction:  Yes No
Remodeling:  Yes No
Service or Repair:   Yes No
Job Location:


Does certificate holder need to be added as additional insured? (If yes, please complete the next questions)

 Yes No
Contract cost of the work to be done for the Additional Insured:

Number of field employees (please include owner as an employee) involved on this job for the Additional Insured?

Length of Job:

Anticipated Start Date:

Would you like to receive an additional insurance quote for:

You may select more than one by pressing the control key while selecting...

If you do not wish to use the form or an error occurred, please feel free to contact us via the website, or call us at (888)467-6612

All information above is used to determine your quote. Mainline Insurance will not give, trade or sell any of the information you have provided to any individual or company for the purpose of profit or gain.


Contractors General Liability Insurance Providers
P.O. Box: PO Box 120640
Chula Vista CA 91912

Phone: 888-467-6612
Fax: 877-467-6610
Lic# 0F23572